Provider Demographics
NPI:1548618564
Name:HOLLATZ, ANGELA (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HOLLATZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 E BISMARCK EXPY
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6603
Mailing Address - Country:US
Mailing Address - Phone:701-255-7220
Mailing Address - Fax:701-255-6029
Practice Address - Street 1:1140 E BISMARCK EXPY
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6603
Practice Address - Country:US
Practice Address - Phone:701-255-7220
Practice Address - Fax:701-255-6029
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH4304183500000X
MN114659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist